"Imagination" Helps Older People Remember to Comply with Medical Advice

A healthy dose of "imagination" helps older people remember
to take medications and follow other medical advice, according to
a new study supported by the National Institute on Aging (NIA),
a part of the National Institutes of Health.

Researchers found older adults who spent a few minutes picturing
how they would test their blood sugar were 50 percent more likely
to actually do these tests on a regular basis than those who used
other memory techniques. The findings by Linda Liu, Ph.D., of the
University of Michigan, and Denise Park, Ph.D., of the University
of Illinois at Urbana-Champaign, appear in the June 2004 issue of
Psychology and Aging. The researchers are part of the CACHET
Center at the University of Michigan and the Center for Healthy
Minds at the University of Illinois. Both are NIA-supported Roybal
Centers for Applied Gerontological Research, which focus on research
of immediate clinical value.

"This is an innovative study. It presents an unusual but apparently
very effective way to use imagination as a memory tool to help older
adults more successfully follow medical instructions," says
Jeffrey Elias, Ph.D., of the NIA's Behavioral and Social Research
Program. "The best medical care in the world isn't much good
if a patient can't or won't follow through. Creative approaches
such as this one need to be explored further if we are to solve
difficult medication adherence problems. The genius of this method
is that it requires less conscious effort than other memory methods.
So, it can be easily learned and applied."

For the study, Liu and Park taught 31 non-diabetic volunteers to do
home blood glucose tests. The researchers chose individuals who didn't
have diabetes in order to simulate the learning conditions faced by
someone who is newly diagnosed with a disease. In addition, because
the blood glucose monitors recorded time- and date-stamps each time
a test was conducted, it allowed the researchers to collect very accurate
data. The participants, ages 60 to 81, were randomly assigned to one
of three groups and told to monitor their blood sugar levels four specific times
daily. They were not allowed to use timers, alarms or other devices.

Those in the implementation group, defined by the investigators
as an "imagination" intervention, spent one 3-minute session
visualizing exactly what they would be doing and where they would
be the next day when they were scheduled to test their blood sugar
levels. Those in the "rehearsal" group repeatedly recited
aloud the instructions for testing their blood. Finally, those in
the "deliberation" group were asked to write a list of
pros and cons for testing blood sugar.

Over the next 3 weeks, participants in the implementation group
remembered 76 percent of the time to test their blood sugar at the
right times of the day compared to an average of 46 percent in the
other two groups. Those in the implementation group were far less
likely to go an entire day without testing than those in the other
two groups. Although the effects observed in this study were large,
NIA scientists note, further studies will be need to be conducted
to replicate the findings more generally.

"Getting older people to remember to take their medications
and conduct self-monitoring tests is a huge issue," Dr. Park
says. "Although many strategies have been tried, none appears
to be as potent or as simple as using one's own imagination. This
study shows it's a powerful and incredibly inexpensive technique
with potentially lasting effects."

Dr. Park suspects that using imagination may be more effective than
other techniques because it relies on automatic memory, a primitive
component of memory that doesn't decline with age. Using this technique,
you might, for example, imagine taking your pills right after you
drink your morning glass of orange juice. The next day at breakfast
taking a sip of orange juice will "automatically" cue
you to take your medication.

"It's not an explicit thought," Dr. Park says. "It's
not as if you think, `Ah, ha! I remember to take my pills now.'
It's more that the orange juice provides an unconscious prompt to,
'Take your meds, take your meds.' "

The NIA, a component of the National Institutes of Health, leads
the federal effort in supporting and conducting basic and clinical
research on aging and the special needs of older people. For information
about the NIA, visit the website at http://www.nia.nih.gov/.
For free brochures and booklets about aging and health topics of
interest to older people, call the NIA Information Center at (800)
222-2225.